Efecto de las estatinas en el desarrollo de síndrome postrombótico: estudio de cohorte / Effect of statins on development of post thrombotic syndrome: cohort study

Resumen Objetivo: Explorar la asociación entre consumo de estatinas (CE) y desarrollo de síndrome postrombótico (SPT). Método: Cohorte retrospectiva con pacientes con primer episodio de trombosis venosa profunda (TVP) entre el 06/2006 y el 12/2017, incluidos en el Registro Institucional de Enfermedad TromboEmbólica (RIET) del Hospital Italiano de Buenos Aires. Se consideró exposición al CE entre los 30 días previos y hasta 180 días posterior al diagnóstico de TVP. Se definió SPT según constaba este dato en la base de seguimiento del RIET. Se evaluó el desarrollo de SPT con un modelo de riesgos proporcionales de Cox, reportando hazard ratios (HR) crudas y ajustadas. Se consideró la confusión por indicación del CE y se utilizó un propensity score (PS) para el ajuste del riesgo estimado, reportando los HR con sus intervalos de confianza del 95% (IC 95%). Resultados: Se incluyeron 905 pacientes, de los cuales 273 fueron CE y 632 no consumidor de estatinas (NCE). Al seguimiento, la incidencia de SPT fue: 6.59% (18) en el grupo CE y 8.07% (51) en el grupo NCE, con p = 0.412. La razón de riesgo para el desarrollo de SPT de CE resultó no significativa (HR cruda: 0.78; IC 95%: 0.43-1.41; p = 0.414). La HR de CE ajustada por edad, sexo, antiinflamatorios no esteroideos, corticosteroides, inmovilidad, anticoagulante, hipertensión arterial, diabetes, dislipidemia, insuficiencia renal crónica, enfermedad coronaria, accidente cerebrovascular, insuficiencia cardiaca y enfermedad oncológica fue 0.45 (IC 95%: 0.13-1.5; p = 0.196). La HR del CE ajustado por edad, sexo, antiinflamatorios no esteroideos, corticosteroides, inmovilidad, tratamiento anticoagulante, enfermedad oncológica y PS fue de 0.52 (IC 95%: 0.17-1.66; p = 0.272). Conclusiones: El CE no se asoció con menor SPT, aunque hubo escaso número de eventos detectados.

Abstract Objective: To evaluate the association between statin consumption and development of post-thrombotic syndrome (PTS). Methods: Retrospective cohort study which included patients with a first episode of deep vein thrombosis (DVT) between 06/2006 and 12/2017, included in the Institutional Registry of ThromboEmbolic Disease of the Italian Hospital of Buenos Aires, Argentina. Exposure to statin use (SU) was considered between the 30 days before and up to 180 days after the diagnosis of DVT. PTS was defined as recorded dataset on registry. The development of PTS was evaluated with Cox proportional hazards model, raw and adjusted hazard ratios (HR) were reported. Confusion was considered by indication of SU and a propensity score (PS) was used for adjustment. We reported HR with their 95% confidence interval (CI); p value < 0.05 was considered statistically significant. Results: Of 1393 patients, 905 were included for the analysis, of which 273 were SU and 632 non-statin users (NSU). At follow-up, incidence of PTS was: 6.59% (18) in the SU group and 8.07% (51) in the NSU group, with p = 0.412. Crude HR for PTS for SU was not significant (0.78; 95% CI: 0.43-1.41; p = 0.414). Adjusted HR of SU by age, sex, non-steroidal anti-inflammatory drugs, corticosteroids, immobility, anticoagulant, high blood pressure, diabetes, dyslipidemia, chronic renal failure, coronary heart disease, stroke, heart failure and cancer disease was 0.45 (95% CI: 0.13-1.5; p = 0.196) for PTS. While HR for the development of PTS adjusted by age, sex, non-steroidal anti-inflammatory drugs, corticosteroids, immobility, anticoagulant treatment, cancer disease and PS of the SU was 0.52 (95% CI: 0.17-1.66; p = 0.272). Conclusion: No statistically significant association was found between CE and the development of SPT, although there were a small number of events detected in both groups.

Análise do grau de recanalização da trombose venosa profunda: estudo comparativo de pacientes tratados com varfarina versus rivaroxabana / Analysis of recanalization of deep venous thrombosis: a comparative study of patients treated with warfarin vs. rivaroxaban

Contexto A trombose venosa profunda (TVP) afeta anualmente cerca de dez milhões de pessoas no mundo e tem como principais complicações a embolia pulmonar e a síndrome pós-trombótica. O tratamento padrão é a anticoagulação, que pode ser realizada com heparinas, antagonistas da vitamina K, fondaparinux ou, mais recentemente, com anticoagulantes orais diretos (direct oral anticoagulants, DOACs). Os anticoagulantes diminuem a progressão do trombo e facilitam os mecanismos trombolíticos naturais, fato conhecido como recanalização, que pode ocorrer em graus e tempos variados, influenciados por diversos fatores, dentre eles o tipo de anticoagulação utilizado. Objetivos Avaliar o grau e o tempo de recanalização através da análise de laudos de eco-Doppler colorido (EDC) de pacientes com TVP tratados com DOACs ou com heparina + varfarina. Métodos Foram avaliados retrospectivamente os dados demográficos e os laudos dos EDC dos pacientes com TVP, tratados entre janeiro de 2009 a dezembro de 2016. Os pacientes foram divididos em dois grupos, de acordo com a terapêutica utilizada: Grupo I (heparina + varfarina): 26 pacientes; Grupo II (rivaroxabana): 51 pacientes. Os principais itens observados foram o grau e o tempo para a recanalização. Resultados Foram observadas taxas de recanalização aos 30, 90 e 180 dias de 10%, 52,5% e 78,9%, respectivamente, no Grupo I, e de 55,3%, 83,5% e 92,4%, respectivamente, no Grupo II, com diferença estatisticamente significativa (p = 0,041). Conclusões Ambos os tratamentos promoveram recanalização. Houve recanalização mais precoce no grupo de pacientes que utilizaram a rivaroxabana

Deep venous thrombosis (DVT) strikes around ten million people worldwide every year and is associated with major complications including pulmonary embolism and post-thrombotic syndrome. Anticoagulation is the standard treatment, with administration of heparins, vitamin K antagonists, fondaparinux, or, more recently, direct oral anticoagulants (DOACs). Anticoagulants reduce thrombus progression and facilitate natural thrombolytic mechanisms, leading to a phenomenon known as recanalization, which can occur in varying degrees and over variable periods of time, under influence from many different factors, including the type of anticoagulation employed. Objectives To evaluate the degree of recanalization and the time taken, by analysis of color Doppler ultrasonography (CDU) reports from patients with DVT treated with DOACs or with heparin + warfarin. Methods A retrospective analysis was conducted of demographic data and CDU reports from patients with DVT who had been treated from January 2009 to December 2016. These patients were classified into two groups, according to the treatment given: Group I (heparin + warfarin): 26 patients; or Group II (rivaroxaban): 51 patients. The primary outcomes assessed were degree of recanalization and time taken. Results Recanalization rates at 30, 90, and 180 days were 10%, 52.5%, and 78.9%, respectively, in Group I, and 55.3%, 83.5%, and 92.4%, respectively, in Group II, with statistically significant difference (p = 0.041). Conclusions Both treatments led to recanalization. Recanalization occurred earlier among patients treated with rivaroxaban

Does Catheter-Directed Thrombolysis Prevent Postthrombotic Syndrome?

PURPOSE: The aim of this study is to identify risk factors of postthrombotic syndrome (PTS) and evaluate the efficacy of catheter-directed thrombolysis (CDT) for preventing the development of PTS in patients with lower extremity deep vein thrombosis (DVT). MATERIALS AND METHODS: From 2005 January to 2013 December, 139 limbs of 126 patients were included in this study who had the first episode of proximal DVT at the affected limb and who had visited our out-patient clinic. CDT was performed on 55 limbs (39.6%). We achieved complete recanalization in 39 limbs (70.9%) and partial recanalization (residual thrombus 0.05). CONCLUSION: We suggest that CDT is not effective in preventing PTS, while higher BMI and longer thrombotic burden are associated with the development of PTS in patients with DVT.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome / Uso da terapia compressiva ou não compressiva na trombose venosa profunda e síndrome pós-trombótica: dois caminhos divergentes

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the "valve mechanism" generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Resumo O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o "mecanismo de válvula" gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

Evolución clínica y ultrasonográfica del síndrome postrombótico en su primer año de evolución / Clinical and ultrasonographic progression of posthrombotic syndrome in its first year

Introduccións: La insuficiencia venosa crónica es característica principal del síndrome postrombótico donde el estasis venoso es típico. Objetivos: Describir la evolución clínica y ultrasonográfica del síndrome postrombótico durante su primer año. Métodos: Estudio descriptivo prospectivo en 20 hombres (55,6 por ciento) y 16 mujeres (44,4 por ciento) con una edad promedio de 55,8 ± 14,2 años (IC95 por ciento : 41,6 ­ 70 años), ingresados en el Servicio de Flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de trombosis venosa profunda de los miembros inferiores. Las variables estudiadas fueron: tipos de síntomas clínicos, tipo de evolución ultrasonográfica por ecodoppler, estadios clínicos del síndrome postrombótico, tiempo y porcentaje de recanalización. Resultadoss: A los seis meses de evolución predominó la sintomatología severa (47,2 por ciento); en el sector fémoro­poplíteo la clasificación de buena. Al año, fue más frecuente la clasificación de moderada (52,8 por ciento) y de muy buena en el sector poplíteo; el edema pretibial fue el signo que predominó. En los sectores ocluidos fémoro-poplíteo el porcentaje de recanalización promedio aumentó al año y fue superior (p < 0,05) al obtenido a los seis meses. Se encontró asociación significativa entre el porcentaje de recanalización y el período de evolución (X2= 41,41; p= 0,0000); y entre el estadio clínico y el porcentaje de recanalización (X2= 32,95; p= 0,0000). Conclusións: durante el primer año de presentarse el síndrome postrombótico pueden ocurrir cambios clínicos y evolución favorable en la recanalización del sistema venoso profundo(AU)

Introduction: Chronic venous insufficiency is the main characteristic of the posthrombotic syndrome where the vein stasis is typical. Objective: to describe the clinical and ultrasonographic progression of the post-thrombotic syndrome in its first year. Methods: A descriptive prospective study was conducted in 20 men (55.6 percent) and 16 women (44.4 percent), with average age of 55.8 ± 14.2 years (IC95 percent : 41.6 ­ 70 years) diagnosed as deep venous thrombosis of the lower limb patients and hospitalized in the phlebolymphology service of the National Institute of Angiology and Vascular Surgery. The studied variables were types of clinical symptoms, type of ultrasonographic progression using Echodoppler device, clinical stagings of the posthrombotic syndrome, and time and percentage of re-canalization. Results: After six months of progression, severe symptoms predominated (47.2 percent); and in the femoral-popliteal area the classification was good. After a year, the moderate classification was more frequent (52.8 percent) and extremely good in the popliteal sector; the pretibial edema was the predominant sign (50 percent). In the occluded popliteal-femoral sector, the percentage of average re-canalization increased after a year, being higher (p< 0.05) than that of six months. A significant association was found between the percentage of re-channeling and the period of progression (X2= 41.41; p= 0.0000); and between the clinical staging and the percentage of re-canalization (X2= 32.95, p= 0.0000). Conclusions: During the first year of existence of the posthrombotic syndrome, clinical changes and favorable progression may occur in the re-canalization of the deep venous system(AU)

Síndrome de May-Thurner como diagnóstico diferencial en trombosis a repetición / May-Thurner syndrome as a differential diagnosis in recurrent thrombosis

El síndrome de May-Thurner es una anomalía anatómica que genera insuficiencia venosa y episodios trombóticos recurrentes de los miembros inferiores. Se presenta el caso de una paciente de 29 años, con cuadro de trombosis venosas profundas en miembros inferiores a repetición desde los 20 años, sin factores de riesgo identificados, en quien se realizan estudios de extensión para neoplasia y trombofilia con resultados negativos, además de estudios para patología reumatológica con anticuerpos antinucleares (ANAS) positivo a títulos bajos como único hallazgo, con lo que se hace diagnóstico de enfermedad del tejido conectivo no diferenciado y se instaura manejo con anticoagulación plena; sin embargo, ante la persistencia de eventos trombóticos se realiza angio-TAC, la cual reporta obstrucción de la vena ilíaca izquierda, por lo cual se realiza una venografía más cavografía documentándose obstrucción de la vena ilíaca externa izquierda y la común estableciéndose el diagnóstico de síndrome de May-Thurner, el cual debe considerarse dentro de los diagnósticos diferenciales de los episodios trombóticos recurrentes.(Acta Med Colomb 2016; 41: 67-70).

The May-Thurner syndrome is an anatomic abnormality generating venous insufficiency and recurrent thrombotic episodes of lower limbs. The case of a 29 years old patient with clinical picture of recurrent deep venous thrombosis in lower limbs since the age of 20 years is presented. No risk factors were identified; extension studies for neoplasia and thrombophilia were performed with negative results, as well as studies for rheumatic disease with positive anti-nuclear antibodies (ANAs) at low titers as unique finding, being diagnosed as undifferentiated connective tissue disease and management with full anticoagulation is established. However, at the persistence of thrombotic events, an angio-CT which reports obstruction of the left iliac vein and the common vein is performed whereby a venography and cavography are done establishing the diagnosis of May Thurner syndrome, which should be considered within the differential diagnosis of recurrent thrombotic events. (Acta Med Colomb 2016; 41: 67-70).

A Case of May-Thurner Syndrome with Systemic Lupus Erythematosus in Antiphospholipid Syndrome / 대한내과학회지

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.

Modalidades terapêuticas da trombose venosa profunda aguda do território iliofemoral / Therapeutic modalities of acute deep vein thrombosis of the iliofemoral territory

A trombose venosa profunda aguda é uma doença bastante frequente, podendo afetar até 5% da população em algum ponto de suas vidas. O acometimento do território iliofemoral é associado com sequelas a curto e longo prazo, tanto físicas, quanto sociais e econômicas. O tratamento padrão com anticoagulação sistêmica atua pouco na prevenção do desenvolvimento da síndrome pós-trombótica. Existem atualmente estratégias direcionadas, incluindo trombectomia cirúrgica, trombólise farmacológica direcionadas por cateter e trombólise farmacomecânica, que podem ser mais eficazes no tratamento dessa afecção. Realizamos uma revisão da literatura no que concerne às indicações, contra-indicações e carcaterísticas de cada modalidade terapêutica atual, comparando os resultados entre elas...

A Case of May-Thurner Syndrome with Systemic Lupus Erythematosus in Antiphospholipid Syndrome / 대한내과학회지

May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.

Extrinsic compression of left iliac vein does not predict the development of post thrombotic syndrome in left side deep venous thrombosis / 대한외과학회지

PURPOSE: Left side deep venous thrombosis (DVT) is associated with May-Thurner's anatomical variation and is often instigated by invasive treatment. The aim of this study is to analyze the influence of left iliac vein narrowness on incidence of post thrombotic syndrome (PTS) that developed after left side DVT. METHODS: Forty-one left side DVT cases that were followed up for more than 1 year were enrolled. The iliac vein narrowness was measured by the shortest distance from the right iliac artery to the 5th lumbar vertebra overlying left iliac vein in computed tomography (CT) scan. The incidence of PTS was measured by phone-call history taking for specific symptoms of PTS. The means of the shortest distance were compared by independent t-test. RESULTS: The number of PTS cases was eleven (26.8%). The level of thrombus, demographic data and other risk factors were similar in both PTS and non-PTS groups except the mean risk factor score. The mean of the shortest distance of PTS group and non-PTS group were 5.56 mm and 5.89 mm, respectively. CONCLUSION: The degree of left iliac vein narrowness measured by the shortest distance from the right iliac artery and the 5th lumbar vertebral body was not a predictive factor for PTS.

Tratamento endovascular das obstruções venosas crônicas do segmento iliocaval / Endovascular treatment of chronic obstructions of the iliocaval segment

A insuficiência venosa crônica é um grave problema de saúde pública no mundo, consumindo grandes quantias de recursos e causando grande prejuízo na qualidade de vida dos pacientes portadores de suas formas mais avançadas. A cirurgia para o tratamento de obstruções no sistema venoso profundo não foi incorporada à prática da maioria dos cirurgiões vasculares, ficando restrita a poucos centros em alguns países. Com o advento da cirurgia endovascular, a possibilidade de tratar alguns tipos de lesões obstrutivas por uma técnica minimamente invasiva e com resultados promissores renova o interesse da comunidade vascular pelas formas mais complexas de doença venosa.

Chronic venous insufficiency is an important public health issue worldwide, that consumes significant amounts of resources and impairs the quality of life of patients who suffer from its more severe clinical types. Surgery for the treatment of deep venous system obstruction has not been incorporated to the practice of most vascular surgeons, being restricted to a few medical centers in some countries. With the advent of endovascular surgical techniques, the possibility of treating some obstructive lesions with a minimally invasive technique that has promising results has renewed the interest of the vascular community for the treatment of more complex forms of vascular disease.

Early surgery for iliac-femoral post-thrombotic syndrome and related experimental study / 中华外科杂志

<p><b>OBJECTIVES</b>To confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment.</p><p><b>METHODS</b>IFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS).</p><p><b>RESULTS</b>The positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05).</p><p><b>CONCLUSIONS</b>The present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.</p>

Trombose venosa profunda dos membros inferiores em crianças e adolescentes tratados em um único centro no Brasil: epidemiologia e evolução / Deep venous thrombosis of lower limbs in children and adolescents treated at a single center in Brazil: epidemiology and evolution

A importância do estudo da trombose venosa profunda (TVP) em crianças e adolescentes reside no impacto desta doença sobre a qualidade de vida desta população, tendo em vista sua longa expectativa de vida e a morbidade associada ao tromboembolismo venoso. Com o passar dos anos, a síndrome pós-trombótica e a recorrência podem deixar sequelas que vão desde dor crônica nos membros, edema e até úlceras de difícil cicatrização. A TVP em crianças está sendo melhor estudada nos últimos anos. Até então, seu diagnóstico e tratamento eram baseados em experiências individuais, pequenas séries de casos ou extrapolados das recomendações para adultos. Realizamos a presente revisão para melhor compreensão da epidemiologia, fisiopatologia, etiologia, diagnóstico, tratamento desta doença.

Screening indices for diagnosis of traditional blood stasis syndrome by Delphi method / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To screening out the indices for diagnosis of traditional blood stasis syndrome (BSS) by investigating experts'experiences, evaluating their significance, for providing reference to the quantitative diagnosis of BSS.</p><p><b>METHODS</b>Using Delphi method, some diagnostic indices that being considered as importance by experts was screened out, and applied in 108 patients to assess their specificity and sensitivity in double-blinded condition, taking the Chinese diagnostic standard as gold standard.</p><p><b>RESULTS</b>Ten indices were screened out from 50 items for traditional observing on BSS, which are considered essential by experts uniform, and showed a coincidence rate of 91.4% when applied for comprehensive diagnosis of BSS.</p><p><b>CONCLUSION</b>The indices for BSS diagnosis screened out by Delphi method can serve as a reference to the BSS quantitative diagnosis.</p>

Catheter-directed Thrombolysis with Urokinase in Deep Venous Thrombosis

PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. METHODS: Between Jan. 1999 and Dec. 2002, 29 consecutive patients with DVT had received thrombolytic therapy. The male: female ratio was 6: 23 and the mean age was 50.3+/-13.5 years. The mean duration of symptom was 9.9+/-22.1 days. Catheter-directed infusions of urokinase were administrated via ipsilateral popliteal veins and the angioplasty and stent placement performed after the thrombolytic procedure. The mean dosage of urokinase and duration of thrombolysis were 2, 435, 000+/-887, 000 units and mean duration of thrombolysis was 36.8+/-17.9 hours. Oral medication of warfarin continued at least six months or more. To evaluate the venous patency, duplex ultrasonography or CT venography were performed. RESULTS: Lysis was complete in 17 patients (58.6%, all acute DVT), partial in 11 (37.9%), with only one patient failing. Iliac vein stenosis had shown in 16 patient after thrombdysis. Which were treated with balloon angioplasty and stent insertion. As a postprocedural complication, vaginal bleeding occurred in two patients; one was treated with transfusion but the other stopped without treatment. CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. However further study will be reguired to evaluate the relationship between the incidence of postthrombotic syndrome and thrombolytic therapy alone.

Endovascular Management of Deep Venous Thrombotic Diseases of the Lower Extremity

Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

Risk Factors and Prophylactic Anticoagulation Therapy of Deep Vein Thrombosis in Lower Extremity

PURPOSE: Deep vein thrombosis of the lower extremity is a frequent disorder which may either occur spontaneously or following a high-risk situation such as major surgical procedures or prolonged period of immobilization. Untreated deep vein thrombosis is associated with morbidity and mortality due to pulmonary embolism and the postthrombotic syndrome. Factors in predicting the risk of deep vein thrombosis can be influenced by the variations of the medical and surgical conditions associated with it. Within the last few years, the knowledge of hereditary and acquired risk factor for deep vein thrombosis have increased, but yet not justified. METHOD: We describe why certain individuals develop deep vein thrombosis at varying times despite of similar risk factors, and also assess risk stratification as well as the value of thromboprophylaxis in medical and surgical patients. From January 1990 to December 1998, 73 patients who have developed deep vein thrombosis were admitted to our hospital. The patients' charts were reviewed retrospectively about risk factors according to age, site, associated medical and surgical conditions. RESULT: The older patients who have developed deep vein thrombosis generally had systemic disease, however the younger patient who have developed deep vein thrombosis had trauma, operation, previous deep vein thrombosis. The duplex scan was sufficient and accurate modality for diagnosis of deep vein thrombosis. CONCLUSION: The patients with risk factor may need to be under close observation and when deep vein thrombosis is diagnosed, prophylactic anticoagulation therapy may be beneficiary for patient's prognosis and pulmonary embolism prevalence. Further clinical research may be needed to help develop accurate methods of risk stratification and to clarify the benefits of thromboprophylaxis in high risk group.